Superior Hypogastric Plexus Block Injections
Superior hypogastric plexus blocks are used to control pelvic pain in patients who have found minimal relief from oral medications or who have found the side-effects from oral medication to be unpleasant. The superior hypogastric plexus contains nerves originating from the descending colon, rectum, testes, penis, prostate, perineum, vulva vagina, uterus, urethra, and bladder. Therefore, the block can help with pain in any of these regions. It can also help with pain secondary to endometriosis, radiation injury, and cancers that metastasize to the pelvis. The superior hypogastric plexus is a retroperitoneal structure, extending bilaterally, just anterior to the vertebral column between the lower third of L5 and the upper third of the S1 vertebral bodies.
Utah Superior Hypogastric Plexus Blocks Treatment
If the patient is physically able and their anatomy allows it, the procedure tends to be done with the posterior approach, where the patient lays face down and the doctor accesses the superior hypogastric plexus through the L5 and S1 vertebra. After being numbed with local anesthetic, two injections will be made using fluoroscopic guidance to ensure proper needle placement. Contrast dye will be used to confirm correct placement before the block is performed. It can be used as therapeutic or diagnostic, depending on the result of the injection. The procedure usually takes less than 15 minutes, after which the physician will monitor your pain and vital signs.
Risks and Benefits
The superior hypogastric plexus block is a minimally invasive procedure that has proven effective in the treatment of chronic pelvic pain, especially when the pain is secondary to malignancy. The risks involved in this procedure are very low, and almost no major complications have ever been reported. As with any procedure, there are theoretical risks that should be considered before treatment is undergone. These risks include bleeding, infection, nerve damage or paralysis, puncturing of surrounding organs and vessels and, if the drug is injected directly into the blood vessel, drug allergy and seizures could occur.
The benefit of superior hypogastric plexus blocks can be temporary for some patients, and every patient will experience a different level of relief. Some individuals will experience relief for weeks, while others experience a reduction of pain for several years. It is a low risk, non-surgical treatment that, if successful the first time, tends to bring continual relief with multiple treatments and reduces the amount of oral medications needed for acceptable pain relief. It has also shown to be very helpful in conjunction with other nerve blocks, such as the ganglion impar block.
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